Surgeons have long known that keeping a patient warm during surgery results
in a more positive outcome. Patients whose bodies are kept at a consistent
temperature during surgical procedures exhibit less blood loss and have
shorter recovery times. These facts were instrumental in the development
of the forced-air warming blanket, invented by Dr. Scott Augustine in 1988.

Dr. Augustine, an anesthesiologist, saw firsthand the adverse effects on
patients who were not kept warm during surgery. Now, however, Dr. Augustine
alleges the Bair Hugger forced-air warming blanket can spread bacteria
in the operating room, leading to serious hospital infections. Dr. Augustine
believes the risks lie primarily in artificial joint implantations such
as knee, hip and artificial heart valves and that there is little risk
in soft joint operations.

In fact, several years ago, Dr. Augustine told doctors to stop using the
Bair Hugger forced-air warming device altogether. Dr. Augustine has also
accused Arizant and 3M of covering up data which supports his theory.
Underlying the controversy between Dr. Augustine and Arizant is the fact
Dr. Augustine resigned as CEO of Arizant—which was once known as
Augustine Medical—in 2002 following a dispute. Arizant and 3M call
Dr. Augustine’s claims nothing more than sour grapes, however research
backs Dr. Augustine’s position.

The Journal of Bone and Joint Surgery published research which found air circulated by the Bair Hugger contained
2,000 times more contaminants as compared to warmers which don’t
use forced-air.1 More research published in The Bone and Joint Journal
found a significant increase in deep joint infection when forced-air warming
devices were used, as compared to conductive fabric warming. McGovern
et al suggested discontinuing the use of forced air warming devices could
potentially decrease infection rates by as much as 74 percent.2

When Dr. Augustines’ latest invention, the HotDog air-free warming
blanket was used, significantly lower infection rates were noted. According
to prweb.com, the use of forced air warming blankets may result in a 3.8
times increase in deep joint infection.3
The AORN Journal noted concerns regarding infection risk from forced air warmers, and asked
manufacturers of forced air warmers to consider redesign due to evidence
of bacteria in the airflow paths.

One hundred ninety-two sources were examined by the
AORN Journal, with a conclusion that “forced-air warmers may interrupt the flow
of filtered air toward the area of the wound and may allow dust particles
containing pathogenic organisms to come in contact with the wound…forced-air
warming and ultraclean ventilation do not mix…”4 Further, the
AORN Journal found a “high risk of developing deep infections for subjects warmed
with forced-air warming systems.”4 In fairness, the authors also
concluded there was not sufficient evidence to conclusively indicate forced-air
warmers are the precise cause of surgical site infections.

The older Bair Hugger models provided approximately 93.8 percent intake
filtration, however the newer models—the ones currently in use,
showed a dismal 63.8 percent intake filtration.5 While the Bair Hugger
was not specifically mentioned by name, a news article published in the
Clinical Quality and Infection Controlquestioned the overall safety risks associated with forced-air warming
blankets. This article concluded the heat in a forced-air warming blanket
escapes near the non-sterile floor of an operating room. These floor-level
pathogens are then lifted by waste heat into the sterile surgical site.

Dangers from Deep Joint Infection

Patients who develop a deep joint infection can face an extremely long,
difficult recovery. In order to get the infection under control as well
as repair the resulting damage, the patient may experience multiple, lengthy
hospitalizations, additional surgical procedures, IV antibiotic therapy
lasting 6-8 weeks, removal and revision of the implant device, extended
physical therapy, and, in extreme cases, amputation of the affected limb.